459 WHITING LN ROOF PERMIT "SS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-ROOF-587
Job Type: ROOF PERMIT
Description: REROOF
Estimated Value: $3,000.00
Issue Date: 12/9/2014
Expiration Date: 6/7/2015
PROPERTY ADDRESS:
Address: 459 WHITING LN
RE Number: 171436-0000
PROPERTY OWNER:
Name: CHIRUMBOLO, DANA
Address: 459 WHITING LN
FEES:
BUILDING PERMIT FEE $65.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $69.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: L, Permit T�Lumber:
_jC Fe-Uw.S
Legal Descriptiiin' D- 9 E�. r-PT 0��Zoel#
Valuation of Work S 1,1oor Area of 'Sq.1,t. Sq.Ft
. 0 Propos( hrikl' oled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial (liesidentia
es 0
If an existing structure,is a fire sprinkler system installed? (Circle one): ;;� N/A
Florida Product Approval # T:L� XCIILA ar%A FL
For multiple products use product approval form
Describe in detail the type of work to be performed: Y-e_wl CA e ejC.'��nQ VpnC oAa4t=j,-, .,.
Property Owner Information:
i In
Name: t,. r v- Address:- 'vr_-4q 1,V 41 ir� a 4A Q
City ft" StatelqZip Phone 4M a--) ?SA Co 7:N
E-Mail or Fax# (Optional)- c�W 011 a C C)
�.d
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: city -State Zip
Office Phone Job Site/Contact Number Fax 4
State Certification/Registration 4
Architect Name&Phone 4
Engineer's Name& Phone 4
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication i's hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be pe�formed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period of six�6)months at any time after
work is commenced. I understand that separate permits must be securedfor Electricaf Work,Plumbing,Sikns, Wells, Pools, Purnaces,Boilers,Heaters,
Tanks andAir Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Ihere certify that I have read and examined th* lication and know the same to be true and correct. All provisions of laws and ordinances governing this
111w0rk will be complied with whether speci ie herei ornot. The granting of a permit does not presume to give authority to violate or cancel the
aw
provisions of any oth>ederal,state, or loNcalre ulatin Mconstri. tion or the performance ofconstruction.
Aignature of Owner Signature of Contractor
Print Name Print Name
Beforeo Before me
this Z /Dav a f 20 this —Day of 20
')-,L� ,
AV N& Notary Public State of Florida
Notary Publi-IN Shirley L Graham Notary Public
My Commission FF 086990
COW? Expires 02114/2018 Revised 01.26.10
CITY OF ATLANTIC BEACH
qVWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSUR-13 STATEMENT FOR SECTION 489.103(7)�FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE'A L'ICENSE. YOU MUST
SUPERVISETHE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 Ol� LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, W141CH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR, YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT is
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY --MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPI OYED I UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
450�t-�W�v-a La-A
91 C.)
PHUNE NUMBER
PRINT NAME
��NATUR F
Before me this tt,of -L4 in the county of
Duval,State of personally appeared h y himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,state of 7V!:A— ,County of
*'P/e'rsonally Known ql,0Z/jq/Z0 2-idx3 .0'0
11 IN
El Produced Identification"- 066990JA U0111wWoo An
W84BJE)'l A904S
eppol.1 jo e4ins oitqnd fUl"ON
Notary Sign,t
a ure,
"" e, f, —7 ,
F:/BLDG/0 Build�r Affidavit;REVISED: 4/16/2009 7
To: Building Dept Page 2 of 2 2015-01-13 14:00:12(GMT) From: Dana Chirumbolo
NOTICE OF COMMENCEMENT
Statc of Florida Tax Folio No. 171.436-0000
CoLmty of—0tival
To Whom It May('oncern:
The undersigned htmeby informs you that improveynents will bc made to certain real property,and in accordance with Section 7 13 of
tho Florida Stawtes,the following information is�tawd in this NOTICE OF C�ONWENCEUMNT.
Legid Doscription of propurty being improyat: 31-16 38-2S-29.E R/P of PT OF ROYAL PALMS UNIT 2A
Address of property being Improve& 459 Whiling Lane, Atlantic Beach,FL 32233,
Generit dncription,of 4n.provenients, Romove,exioing,rootina niaterial&re-roor
Owner, Dana Chirutribolo Addrews: 459 Whitine Lanc-Atlantic Beac FL 32.
Owner's interest in site of-the finprovement: ..........
Fee Simple Titleholder(if other than owner),
----------
Contractor
Address:— la bm zzo4z�9
Telephone No.: Fax No: 9 .C L4
Surety(il'any)
Address: Amount of Bond
TQlephonc'No; No:
Do;�';;20150')777 6,OR 5K 1.7u�U �Iage-36,
Name and addr"s ofarly person making a loan for the construction ofthc improvements. Mxr1bt'l,PdCd5:J
v
5 At Od:'-,'4 AM,
Name: Rciiiiiu Fusz�l?C'_FPK(ARGUT'COURT DdivAL
Address: 4 E C 0--1 ID:!,;G�,$1 Ci,CC,
Phone No: Fwx No:
Name of person within the State of Florida.. other than himself, designated by owner upon whorn notices or other dOCUments may be
%erved: Name:
Addrcss�
Telephone No: ]�'wx No: ......
Tn addition to himself, owner dosIgnaLo, .1bo following Person to receive a copy or the Lienor's Notice as provi&d in S'", tion
713,06('22.)(b),Flonda Stittues. (fill inat-Owner's 0-ptiork)
Nan)e' ........
Address:_ .... ..... ........
Telephone N'o; Fax No:
JiNpirationdate ot"Notice ot, (ibo expiration(late it;one (1)ycar lirom the datz ofrowrding unluss a diflkent date is
specified),_M—arch I� 0�15 ...........
THIS SPACE FOR RECORDER"S 1JS'E ONLY OWNE
Date:
!�n the C�6ntj ol'Duval,Sttd:c
Of Florida,haq personal ly appeared
JEN G STEMACK Da.
Notary PublicatLarge,S'tatc of Florida,County of5-UNral.
MY COMMMS*N t EF-11 77M
my Commission ov' 11.0s;
EXPRES March D8.2016 ref-solrully Kiiown; Qr